Active NPI
Jeffrey John Elenewski, PHD
- Clinical Psychologist
- Colorado Springs, CO
National Provider Identifier
1376704841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2980
- Practice address
- 4645 Spring Canyon HTS
Colorado Springs, CO 80907-9403 - Phone
- (719) 622-6887
- NPI assigned
- Jun 18, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2980 | CO | Primary |
Addresses
Primary practice location
4645 Spring Canyon HTS
Colorado Springs, CO 80907-9403
Mailing address
4860 Robb St Ste 201
Wheat Ridge, CO 80033-2162
Phone (303) 278-7418
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13578071 | Other | CO | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2980 | CO | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elizabeth Johnson, PHD., LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Colorado Springs, CO
- NPI 1164037552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435190400000",
"number": "1376704841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4860 ROBB ST STE 201",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800332162",
"telephone_number": "303-278-7418",
"fax_number": "888-341-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4645 SPRING CANYON HTS",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809079403",
"telephone_number": "719-622-6887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELENEWSKI",
"first_name": "JEFFREY",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-18",
"last_updated": "2015-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "2980",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "13578071",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.